Repair options in rheumatic aortic valve disease in young patients: potential problems with pericardial cusp extension.

This article outlines the arguments against cusp extension, which were put forward at the debate entitled "Repair options in rheumatic aortic disease in young patients" at the Symposium on Surgery for Rheumatic Heart Disease organized by The World Society for Pediatric and Congenital Heart Surgery at The Sixth World Congress of Paediatric Cardiology and Cardiac Surgery, February 17-22, 2013, Cape Town, South Africa. We propose that cusp extension should be avoided because (1) these patients are usually old enough to receive the same valve substitutes as adults, (2) lack of antibioprophylaxis compliance will likely result in early reintervention, (3) cusp extension mandates rerepair within four to five years and is more expensive in the long term, and (4) it is fraught with myocardial ischemic complications. Thus, a mechanical, bioprosthetic, or autograft valve replacement may be superior for patients unless they have unrestricted access to repetitive interventions. A single surgical technique does not suffice in the treatment of rheumatic aortic valve disease, and a diversified approach should be adopted dependent on both the patients' characteristics and the financial constraints.